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Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S. children and adolescents aged 5-18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19-related hospitalizations was 52% (95% CI = 33%-66%) when the most recent dose was administered <120 days before hospitalization and 19% (95% CI = 2%-32%) if the interval was 120-364 days. VE of the original monovalent vaccine against COVID-19-related hospitalization was 31% (95% CI = 18%-43%) if the last dose was received any time within the previous year. VE against critical COVID-19-related illness, defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death, was 57% (95% CI = 21%-76%) when the most recent dose was received <120 days before hospitalization, 25% (95% CI = -9% to 49%) if it was received 120-364 days before hospitalization, and 38% (95% CI = 15%-55%) if the last dose was received any time within the previous year. VE was similar after excluding children and adolescents with documented immunocompromising conditions. Because of the low frequency of children who received updated COVID-19 vaccines and waning effectiveness of original monovalent doses, these data support CDC recommendations that all children and adolescents receive updated COVID-19 vaccines to protect against severe COVID-19.
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Vacunas contra la COVID-19 , COVID-19 , Humanos , Adolescente , Niño , Estados Unidos/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas de ARNm , Eficacia de las Vacunas , SARS-CoV-2 , Hospitalización , ARN MensajeroRESUMEN
Bloodstream infection poses a significant medical emergency that necessitates timely administration of appropriate antibiotics. Standard laboratory workup for antimicrobial susceptibility testing (AST) involves subculture of organisms from positive blood bottles followed by testing using broth microdilution; however, this process can take several days. The Accelerate Pheno Blood Culture panel (Pheno) provides rapid phenotypic testing of selected Gram-negative organisms directly from positive blood cultures. This has the potential to shorten the AST process to several hours and impact time to antimicrobial optimization and subsequent clinical outcomes; however, these metrics have not been assessed in pediatric populations. We retrospectively compared two patient cohorts with blood cultures positive for on-panel Gram-negative organisms: 82 cases tested by conventional AST methods, and 80 cases postintervention at our pediatric hospital. Susceptibility testing from the Pheno yielded 91.5% categorical agreement with a broth microdilution-based reference method with 7.4% minor error, 1.1% major error, and 0.1% very major error rates. The median time from blood culture positivity to AST decreased from 20.0 h to 9.7 h (P < 0.001), leading to an overall decrease in time from blood culture positivity to change in therapy from 36.0 h to 25.0 h (P < 0.001). There was no observed change in length of stay or 30-day mortality. Median duration on meropenem decreased from 64.8 h to 31.6 h (P = 0.04). We conclude the Pheno had accurate performance and that implementation allowed for faster AST reporting, improved time to optimal therapy, and decreased duration on meropenem in children.
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Antiinfecciosos , Bacteriemia , Infecciones por Bacterias Gramnegativas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Niño , Bacterias Gramnegativas , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Hospitales Pediátricos , Humanos , Meropenem , Pruebas de Sensibilidad Microbiana , Estudios RetrospectivosRESUMEN
Viral respiratory tract infections cause significant morbidity in bone marrow transplant (BMT) patients. Speed and sensitivity of the FilmArray™ Respiratory Panel (FA-RP) can improve care but may prompt inappropriate testing. Studies describing FA-RP use in pediatric BMT patients are limited; we investigated FA-RP use, results, and clinical management to evaluate clinical significance of testing in pediatric BMT patients. Retrospective analysis of 671 respiratory specimens from 204 unique BMT patients between 01/01/2016 and 01/01/2019 was performed. Age, underlying diagnoses, FA-RP result, reason for FA-RP, and symptoms were abstracted. FA-RP impact on antimicrobial management, scheduled procedures, infection control measures, and hospital admission/discharge were investigated. Impacts of repeat testing were evaluated. Two hundred sixty-nine out of 671 specimens (40%) tested positive; human rhinovirus/enterovirus (hRV/hEV) was the most common (161/269, 60%). The primary reason for FA-RP was URI symptoms (402/671, 60%) with 54% testing positive. One hundred twenty-two out of 671 (18.2%) specimens were from asymptomatic patients; 14 (11.4%) tested positive. FA-RP informed antiviral initiation in 7/19 (36.8%), 7/8 (87.5%), and 5/30 (16.7%) of RSV, influenza, and human parainfluenza cases, respectively. In 11 cases, FA-RP informed azithromycin and ceftriaxone initiation, continuation, or discontinuation. BMT was delayed for three positives (two RSV, one hRV/hEV). In 22 instances, negative FA-RP cleared patients for BMT. In 70% of cases, repeats offered no new clinical information; all negative-to-positive cases had new or worsening respiratory symptoms. FA-RP was ordered on symptomatic and asymptomatic patients, provided rapid diagnosis in > 50% of symptomatic patients, and informed infection control measures for all inpatients and antiviral initiation in > 80% of influenza cases.
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Infecciones del Sistema Respiratorio , Virus , Trasplante de Médula Ósea/efectos adversos , Niño , Humanos , Lactante , Sistema Respiratorio , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Estudios RetrospectivosRESUMEN
Isavuconazole is a broad-spectrum azole anti-fungal not yet approved in children. We conducted a retrospective, single-center review of isavuconazole use and routine therapeutic drug monitoring in pediatric patients, extracting demographic, dosing, concentration, mortality and hepatoxicity data. We constructed a nonparametric population model using Pmetrics. Of 26 patients, 19 (73%) were male. The mean (SD) age and weight were 12.7 (5.5) years and 50.9 (26.8) kg. Eighty percent received between 9.7 and 10.6 mg/kg per dose. Ten (38%) subjects had proven fungal disease and eight (31%) had probable disease, mostly with Candida and Aspergillus spp. The predicted steady-state isavuconazole concentrations in our patients were similar to previous reports in children and adults, and simulations with the proposed dosing of 10 mg/kg/dose every 8 h for 2 days followed by once daily maintenance matched effective adult exposures. Attributable mortality (5 of 11 deaths) was associated with steady-state daily AUC < 60 mg∗h/L and higher AST/ALT with trough concentrations > 5 mg/L. Neither dose nor trough alone correlated well with AUC, but AUC can be estimated with one sample 10 h after the first maintenance dose or a trough concentration, if combined with a Bayesian approach or a peak and trough without a Bayesian approach.
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OBJECTIVE: To describe the similarities and differences in the evaluation and treatment of multisystem inflammatory syndrome in children (MIS-C) at hospitals in the US. STUDY DESIGN: We conducted a cross-sectional survey from June 16 to July 16, 2020, of US children's hospitals regarding protocols for management of patients with MIS-C. Elements included characteristics of the hospital, clinical definition of MIS-C, evaluation, treatment, and follow-up. We summarized key findings and compared results from centers in which >5 patients had been treated vs those in which ≤5 patients had been treated. RESULTS: In all, 40 centers of varying size and experience with MIS-C participated in this protocol survey. Overall, 21 of 40 centers required only 1 day of fever for MIS-C to be considered. In the evaluation of patients, there was often a tiered approach. Intravenous immunoglobulin was the most widely recommended medication to treat MIS-C (98% of centers). Corticosteroids were listed in 93% of protocols primarily for moderate or severe cases. Aspirin was commonly recommended for mild cases, whereas heparin or low molecular weight heparin were to be used primarily in severe cases. In severe cases, anakinra and vasopressors frequently were recommended; 39 of 40 centers recommended follow-up with cardiology. There were similar findings between centers in which >5 patients vs ≤5 patients had been managed. Supplemental materials containing hospital protocols are provided. CONCLUSIONS: There are many similarities yet key differences between hospital protocols for MIS-C. These findings can help healthcare providers learn from others regarding options for managing MIS-C.
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COVID-19/terapia , Protocolos Clínicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Antiinflamatorios no Esteroideos/uso terapéutico , Anticoagulantes/uso terapéutico , Antirreumáticos/uso terapéutico , Aspirina/uso terapéutico , COVID-19/diagnóstico , Niño , Estudios Transversales , Glucocorticoides/uso terapéutico , Heparina/uso terapéutico , Hospitales , Humanos , Inmunoglobulinas Intravenosas , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Encuestas y Cuestionarios , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Estados Unidos/epidemiología , Vasoconstrictores/uso terapéuticoAsunto(s)
Infecciones por Coronavirus/patología , Enfermedades del Recién Nacido/patología , Enfermedades del Recién Nacido/virología , Neumonía Viral/patología , Insuficiencia Respiratoria/virología , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Masculino , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/etiología , Tratamiento Farmacológico de COVID-19Asunto(s)
Criptococosis , Cryptococcus , Neutropenia Febril , Moraxella , Infecciones por Moraxellaceae , Sepsis , Femenino , Humanos , Lactante , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Cultivo de Sangre , Criptococosis/complicaciones , Criptococosis/diagnóstico , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Cryptococcus/aislamiento & purificación , Resultado Fatal , Neutropenia Febril/sangre , Neutropenia Febril/diagnóstico , Neutropenia Febril/tratamiento farmacológico , Neutropenia Febril/microbiología , Histiocitosis de Células de Langerhans/tratamiento farmacológico , Histiocitosis de Células de Langerhans/inmunología , Pruebas de Sensibilidad Microbiana , Moraxella/aislamiento & purificación , Infecciones por Moraxellaceae/complicaciones , Infecciones por Moraxellaceae/diagnóstico , Infecciones por Moraxellaceae/tratamiento farmacológico , Infecciones por Moraxellaceae/microbiología , Sepsis/sangre , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Índice de Severidad de la EnfermedadRESUMEN
Herpes simplex virus (HSV) infections of the central nervous system (CNS) are associated with significant morbidity and mortality rates in children. This study assessed the impact of a direct HSV (dHSV) PCR assay on the time to result reporting and the duration of acyclovir therapy for children with signs and symptoms of meningitis and encephalitis. A total of 363 patients with HSV PCR results from cerebrospinal fluid (CSF) samples were included in this retrospective analysis, divided into preimplementation and postimplementation groups. For the preimplementation group, CSF testing was performed using a laboratory-developed real-time PCR assay; for the postimplementation group, CSF samples were tested using a direct sample-to-answer assay. All CSF samples were negative for HSV. Over 60% of patients from both groups were prescribed acyclovir. The average HSV PCR test turnaround time for the postimplementation group was reduced by 14.5 h (23.6 h versus 9.1 h; P < 0.001). Furthermore, 79 patients (43.6%) in the postimplementation group had dHSV PCR results reported <4 h after specimen collection. The mean time from specimen collection to acyclovir discontinuation was 17.1 h shorter in the postimplementation group (31.1 h versus 14 h; P < 0.001). The median duration of acyclovir therapy was also significantly reduced in the postimplementation group (29.2 h versus 14.3 h; P = 0.01). Our investigation suggests that implementation of rapid HSV PCR testing can decrease turnaround times and the duration of unnecessary acyclovir therapy.
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Aciclovir/uso terapéutico , Encefalitis por Herpes Simple/diagnóstico , Encefalitis por Herpes Simple/tratamiento farmacológico , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Meningitis/diagnóstico , Meningitis/tratamiento farmacológico , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Adolescente , Adulto , Antivirales/uso terapéutico , Sistema Nervioso Central/virología , Líquido Cefalorraquídeo/virología , Niño , Preescolar , Encefalitis por Herpes Simple/virología , Femenino , Herpesvirus Humano 1/genética , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/virología , Estudios Retrospectivos , Adulto JovenRESUMEN
A diagnosis of brucellosis can be difficult because routine culture and serological methods exhibit variable sensitivity and specificity. We present the use of a metagenomic next- generation sequencing assay to diagnose a case of neurobrucellosis from cerebrospinal fluid, resulting in the institution of appropriate antibiotic treatment and a favorable clinical outcome.
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Brucelosis/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Brucella/genética , Brucelosis/líquido cefalorraquídeo , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Metagenómica/métodos , Médula Espinal/diagnóstico por imagenRESUMEN
Direct microbial DNA detection from clinical specimens by polymerase chain reaction and Sanger sequencing has been developed to address the innate limitations of traditional culture-based work-up. We report our institution's experience with direct specimen sequencing, its clinical utility, and barriers to effective clinical implementation.
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Infecciones Bacterianas/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Micosis/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Análisis de Secuencia de ADN/métodos , Adolescente , Infecciones Bacterianas/microbiología , Niño , Preescolar , Humanos , Lactante , Micosis/microbiologíaRESUMEN
We report an unusual cluster of invasive group A Streptococcus infections in 6 pediatric patients and demonstrate that the strains were derived from diverse genetic backgrounds, confirming the occurrence of a community cluster rather than a clonal outbreak. Whole genome sequencing provided a rapid and comprehensive view of group A Streptococcus genotypes and helped guide our institutional response and public health maneuvers.
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Bacteriemia/microbiología , ADN Bacteriano/análisis , Genoma Bacteriano/genética , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/genética , Adolescente , Antibacterianos/farmacología , Niño , Preescolar , ADN Bacteriano/genética , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Análisis de Secuencia de ADN , Streptococcus pyogenes/efectos de los fármacos , Streptococcus pyogenes/patogenicidadRESUMEN
This report details how social media communication was used in a group of teens to diagnose cutaneous leishmaniasis that they acquired during a trip to Israel. Their posts quickly brought the cluster to the attention of the teens and their parents, leading to prompt recognition of the true etiology of their lesions and appropriate treatment.
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Brotes de Enfermedades , Leishmaniasis Cutánea/diagnóstico , Medios de Comunicación Sociales , Adolescente , Femenino , Humanos , Israel , Leishmaniasis Cutánea/epidemiología , ViajeRESUMEN
The co-existence of multiple genotypes in colonization by Staphylococcus aureus has not been fully investigated. The aim of this study was to evaluate the heterogeneity of S. aureus carriage in children. We evaluated 125 nasal and perianal swab samples that were positive for S. aureus from 76 children scheduled for elective surgery. For each sample, at least four colonies with the same or different morphotypes were selected for analysis. Multiple-locus variable-number tandem-repeat fingerprinting was used to determine the genetic relatedness and to characterize the clonality of the S. aureus strains. Of the 125 swabs, 91 (73â%) contained meticillin-sensitive S. aureus (MSSA), 8 (6â%) contained meticillin-resistant S. aureus (MRSA), and 26 (21â%) contained MSSA and MRSA simultaneously. A total of 738 S. aureus strains were evaluated with a mean of 6 colonies (range 4-15) picked from each culture. Of the 125 swabs, 32 (26â%) samples contained two genetically distinct S. aureus strains and 6 (5â%) contained three different genotypes. Multiple S. aureus strains simultaneously carried by individual children were genetically unrelated to each other. We concluded that the co-existence of multiple genotypes of S. aureus was common. The significance of multiple carriage is yet to be determined, but this intraspecies interplay could be important to pathogenicity and virulence in S. aureus.
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Técnicas de Tipificación Bacteriana , Portador Sano/microbiología , Tipificación Molecular , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/aislamiento & purificación , Niño , Preescolar , Análisis por Conglomerados , Dermatoglifia del ADN , ADN Bacteriano/genética , Genotipo , Humanos , Resistencia a la Meticilina , Repeticiones de Minisatélite , Nariz/microbiología , Perineo/microbiología , Staphylococcus aureus/genéticaRESUMEN
In a survey of staphylococcal colonization, Staphylococcus aureus was detected in 7 of 67 infants (10%). Two of the infants (3%) carried methicillin-resistant S aureus (MRSA), revealing an unsuspected transmission of MRSA within the neonatal intensive care unit. Molecular surveillance of S aureus provided useful information to improve infection control practices.
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Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Técnicas de Tipificación Bacteriana , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , ADN Bacteriano/análisis , Brotes de Enfermedades/prevención & control , Hospitales de Enseñanza , Humanos , Higiene , Illinois , Lactante , Recién Nacido , Control de Infecciones , Resistencia a la Meticilina , Aislamiento de Pacientes , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , Infecciones Estafilocócicas/prevención & control , Infecciones Estafilocócicas/transmisiónRESUMEN
We investigated whether methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) isolates with low-level mupirocin resistance can serve as recipients of a pSK41-like plasmid conferring high-level mupirocin resistance without substantial fitness cost. Our results suggest that acquisition of the plasmid conferring high-level mupirocin resistance was not necessarily associated with fitness cost in some MRSA recipients with low-level mupirocin resistance.
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Antibacterianos/farmacología , Proteínas Bacterianas/genética , Conjugación Genética , Farmacorresistencia Bacteriana/genética , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Mupirocina/farmacología , Humanos , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/crecimiento & desarrollo , Pruebas de Sensibilidad Microbiana , Plásmidos , Infecciones Estafilocócicas/microbiologíaRESUMEN
BACKGROUND: The nation-wide concern over methicillin-resistant Staphylococcus aureus (MRSA) has prompted many clinicians to use vancomycin when approaching patients with suspected staphylococcal infections. We sought to characterize the epidemiology of community-onset S. aureus infections in hospitalized children to assist local clinicians in providing appropriate empiric antimicrobial therapy. METHODS: From January 2005-June 2008, children (0-18 years old) admitted to the Children's Hospital of Illinois with community-onset S. aureus infections were identified by a computer-assisted laboratory-based surveillance and medical record review. RESULTS: Of 199 patients, 67 (34%) had invasive infections, and 132 (66%) had skin and soft tissue infections (SSTIs). Among patients with invasive infections, S. aureus isolates were more likely to be susceptible to methicillin (MSSA 63% vs. MRSA 37%), whereas patients with SSTIs, S. aureus isolates were more likely to be resistant to methicillin (MRSA 64% vs. MSSA 36%). Bacteremia and musculoskeletal infections were the most common invasive infections in both groups of S. aureus. Pneumonia with empyema was more likely to be caused by MRSA (P = 0.02). The majority (approximately 90%) of MRSA isolates were non-multidrug resistant, even in the presence of healthcare-associated risk factors. CONCLUSION: Epidemiological data at the local level is important for antimicrobial decision-making. MSSA remains an important pathogen causing invasive community-onset S. aureus infections among hospitalized children. In our hospital, nafcillin in combination with vancomycin is recommended empiric therapy in critically ill patients with suspected invasive staphylococcal infections. Because up to 25% of MSSA circulating in our area are clindamycin-resistant, clindamycin should be used cautiously as empiric monotherapy in patients with suspected invasive staphylococcal infections.
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Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/epidemiología , Hospitales Pediátricos , Infecciones Estafilocócicas/epidemiología , Adolescente , Niño , Preescolar , Clindamicina/uso terapéutico , Femenino , Humanos , Illinois/epidemiología , Lactante , Recién Nacido , Masculino , Staphylococcus aureus Resistente a Meticilina , Nafcilina/uso terapéutico , Vancomicina/uso terapéuticoRESUMEN
BACKGROUND: Staphylococcus aureus is a major cause of surgical wound infections. To obtain contemporary data on S aureus, we performed a prospective study of colonization and infection in children scheduled for elective surgical procedures. METHODS: A nasal swab and clinical information were obtained at the presurgical outpatient visit. At operation, nasal and perianal swabs were obtained. S aureus were isolated and characterized. RESULTS: We enrolled 499 patients from June 2005 to April 2007. Wound classes were 1 (73%), 2 (22%), 3 (5%), and 4 (0.2%). Prophylactic antibiotics were administered for 153 (31%). Postoperative length of stay ranged from 0 (77%) to 6 days, with 19 (4%) staying 4 days or more. Screening cultures grew S aureus for 186 procedures (36.6%); of these, 141 were methicillin-resistant S aureus (MRSA) (76% of all staphylococcal cultures or 28% of all procedures). Most MRSA had Staphylococcal Chromosomal Cassette mec type II and resistance to clindamycin-typical for hospital-associated strains. There were 10 (2%) surgical site infections, including 4 methicillin-sensitive S aureus, 1 MRSA, 2 with no growth, and 2 with no cultures. CONCLUSION: Methicillin-resistant S aureus colonization was common in asymptomatic children. Most strains appeared to be health care-associated and resistant to clindamycin. Wound infection rate remained low despite the high prevalence of staphylococcal colonization.